Sunday

Jan 21, 2018 at 6:46 PMJan 21, 2018 at 6:46 PM

VA will begin processing claims for reimbursement of reasonable costs that were only partially paid by a veteran’s other health insurance. Those costs may include hospital charges, professional fees and emergency transportation such as ambulances.

The U.S. Department of Veterans Affairs announced Jan. 10 that it has, through a Federal Register notice, revised its regulations concerning payment or reimbursement for emergency treatment for non-service connected conditions at non-VA facilities.

VA will begin processing claims for reimbursement of reasonable costs that were only partially paid by a veteran’s other health insurance. Those costs may include hospital charges, professional fees and emergency transportation such as ambulances.

This change comes on the heels of an earlier announcement that VA was taking immediate action to address delayed payments to community providers. Effective Jan. 9, VA updated a portion of its regulations in response to an April 2016 U.S. Court of Appeals for Veterans Claims decision that stated VA could no longer deny reimbursement when a veteran’s other health insurance pays a portion of the treatment expenses.

VA will apply the updated regulations to claims pending with VA on or after April 8, 2016, and to new claims. By law, VA still may not reimburse veterans for the costs of copayments, cost shares and deductibles required by their other health insurance.

VA will work directly with community providers to get additional information needed to review and process these claims. Previous claims do not have to be resubmitted unless requested by VA. More information on the amended regulation along with guidance may be found online at http://bit.ly/2Dgsqy8.

VA employee union

calls for investigation

The nation’s largest federal union, the American Federation of Government Employees, sent a letter on Jan. 9 to the U.S. House and Senate Veterans’ Affairs leadership calling for an investigation into the two main contractors running the controversial Choice program that allegedly have defrauded taxpayers by nearly $90 million. The Veterans Choice Program allows eligible veterans to receive health care in their communities rather than waiting for a VA appointment or traveling over a distance to a VA facility.

AFGE, which represents 250,000 front-line workers at the Department of Veterans Affairs, more than 100,000 of whom are veterans themselves, sent the letter from National President J. David Cox Sr. to U.S. House Committee of Veterans’ Affairs Chair Rep. Phil Roe of Tennessee, Ranking Member Rep. Mark Takano of California, Oversight and Investigations Subcommittee Chair Rep. Jack Bergman of Michigan, Ranking Member Rep. Ann Kuster of New Hampshire, and U.S. Senate Committee on Veterans’ Affairs Chair Sen. Johnny Isakson of Georgia and Ranking Member Sen. Jon Tester of Montana.

In a September memo by the VA Office of Inspector General, titled "Accuracy and Timeliness of Payments Made Under the Choice Program Authorized by the Veterans Access, Choice, and Accountability Act," it was found that at least two third-party administrators of the VA Choice Program had led to $90 million in improper charges to the American taxpayer.

Cox said in the letter, "The questionable practices used by third-party administrators of the VA Choice Program, TriWest and HealthNet, including double billing and improper payment rates, have directly harmed veterans and undermined the capacity of the VA health care system to provide them with the exemplary care that they have earned with their service." It added that the union "respectfully requests that the House Veterans’ Affairs Committee and the Sub-Committee on Oversight and Investigations conduct oversight hearings into the contractors’ billing practices and the VA’s effectiveness in overseeing these contracts."

The revelations of overcharging by third-party administrators is just the latest controversy plaguing the Choice program, which allows veterans to obtain quicker, local medical appointments than at a VA facility. Last month, the House Committee on Veterans’ Affairs voted along party lines to pass H.R. 4242 — VA Care in the Community Act — which would continue to funnel funding away from veterans’ first and best choice for health care at VA facilities, and sticking them in the back of the line at unaccountable, private, for-profit providers.

Representative Takano attempted to submit three amendments to H.R. 4242, to increase hiring and improve accountability of the Choice program, but committee Republicans voted down each on party-line votes.

"Thank you to Rep. Takano and to the Committee Democrats who all tried to stand up to Republicans and protect veterans’ health care. This year we have continued to hear veterans and their service organizations tell us how important VA care is, and how we cannot let it be dismantled and auctioned off to unqualified for-profit providers," said Cox.

"H.R. 4242 is a terrible piece of legislation that not only chips away at the only health care system tailored to the unique needs of veterans, but it also insulates private, for-profit providers from being accountable to veterans or taxpayers. We keep hearing from Congress and the administration that there needs to be a greater level of accountability, but when it came down to making sure these private providers would be accountable to the men and women who served this country, party politics won out," he added.

Events at Providence

VA Medical Center

— The Providence VA Medical Center Homeless Patient-Aligned Care Team clinic will host a winter coat giveaway event organized by Operation Stand Down Rhode Island, lasting from 9:30 a.m. to 12:30 p.m., on Friday, Jan. 26, at Trailer 37 on the Providence VAMC Campus, 830 Chalkstone Ave. Winter clothing will include coats, jackets, hats, gloves and other winter clothing. Lunch will also be provided at the event.

— The Providence VAMC plans to "Go Red for Women and Celebrate Heart Health Day" on Friday, Feb. 2, with a resource table available to all, from 9 a.m. to noon, in the basement canteen, main hospital building. Attendees are encouraged to wear red attire in support of the event, which is a collaborative effort to raise heart health awareness by Providence VAMC Nutrition Services and Women’s Health Services.